The cost‐effectiveness of dapagliflozin compared to DPP‐4 inhibitors in the treatment of type 2 diabetes mellitus in the Netherlands

Abstract Aim When glycaemic control for people with type 2 diabetes is not achieved with metformin and sulfonylurea alone, adding another oral anti‐diabetes drug, such as a sodium–glucose co‐transporter 2 (SGLT2) or dipeptidyl peptidase‐4 (DPP‐4) inhibitor, is an alternative to starting insulin. The aim of this study is to determine the cost‐effectiveness of dapagliflozin (an SGLT2 inhibitor) compared with DPP‐4 inhibitors when added to metformin and sulfonylurea in people with type 2 diabetes in the Netherlands. Methods A cost–utility analysis is performed using the Cardiff diabetes model, a... Mehr ...

Verfasser: Van der Linden, N.
Van Olst, S.
Nekeman, S.
Uyl‐de Groot, C.A.
Dokumenttyp: Artikel
Erscheinungsdatum: 2020
Reihe/Periodikum: Diabetic Medicine ; volume 38, issue 4 ; ISSN 0742-3071 1464-5491
Verlag/Hrsg.: Wiley
Sprache: Englisch
Permalink: https://search.fid-benelux.de/Record/base-29222024
Datenquelle: BASE; Originalkatalog
Powered By: BASE
Link(s) : http://dx.doi.org/10.1111/dme.14371

Abstract Aim When glycaemic control for people with type 2 diabetes is not achieved with metformin and sulfonylurea alone, adding another oral anti‐diabetes drug, such as a sodium–glucose co‐transporter 2 (SGLT2) or dipeptidyl peptidase‐4 (DPP‐4) inhibitor, is an alternative to starting insulin. The aim of this study is to determine the cost‐effectiveness of dapagliflozin (an SGLT2 inhibitor) compared with DPP‐4 inhibitors when added to metformin and sulfonylurea in people with type 2 diabetes in the Netherlands. Methods A cost–utility analysis is performed using the Cardiff diabetes model, a fixed‐time increment stochastic simulation model informed by ‘United Kingdom Prospective Diabetes Study 68’ risk equations. The base‐case analysis uses a 40‐year time horizon, a Dutch societal perspective and differential discounting (4% for costs, 1.5% for effects). Inputs are obtained from the literature and Dutch price lists. Univariate and probabilistic sensitivity analysis are performed. Results Dapagliflozin is dominant compared with DPP‐4 inhibitors, resulting in a €990 cost saving and a 0.28 quality‐adjusted life year gain over 40 years. Cost savings are associated mainly with treatment costs and a reduced incidence of micro‐ and macrovascular complications, among others nephropathy, myocardial infarction and stroke. Results are robust to changes in input parameters. Conclusions Dapagliflozin is a cost‐saving alternative to DPP‐4 inhibitors when added to metformin and sulfonylurea. The incidence of micro‐ and macrovascular complications is lower for people treated with dapagliflozin. Uncertainty around this outcome is low.